启东市1972－2016年非霍奇金淋巴瘤生存率及其长期变化趋势

目的:对启东市1972－2016年全人群非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)发病病例进行生存率分析，为预后评价及防治提供依据。方法:对1 990例NHL登记病例进行生存结局随访，随访截止日期为2021年12月31日。SURV3.01软件中Hakulinen方法计算观察生存率(observed survival rate,OSR)和相对生存率(relative survival rate,RSR)，应用Hakulinen氏似然比检验法进行统计学检验。用Joinpoint4.7.0.0统计软件进行Joinpoint回归分析，计算NHL生存率年度变化百分比(annual percentage change，APC)，对NHL总体生存率、分性别及分年龄别生存率作时间趋势分析，判断生存率的长期趋势变化是否存在统计学差异，并用SAS9.2软件采用时间序列分析中的ARIMA模型进行NHL生存率趋势预测。结果:启东市1972-2016年NHL 1、5、10年OSR分别为39.00%、20.39%及15.53%；1、5、10年RSR分别为40.18%、23.82%及21.46%。1972-2016年各时期生存率分析，1-RSR从1972-1976年的36.66%升至2012-2016年的55.21%，5-RSR从1972-1976年的12.50%升至2012-2016年的36.56%，10-RSR从1972-1976年的10.92%升至2007-2011年的22.43%，九个时期的RSR上升趋势有统计学意义(χ2=173.74，P<0.001)。男性5年RSR为21.55%，女性5年RSR为27.12%，男女性之间RSR差异无统计学意义(χ2=11.54，P＝0.399)。35~44岁、45~54岁、55~64岁、65~74岁及≥75岁的5年RSR分别为23.62%、23.69%、27.87%、22.93%和14.23%，各年龄组之间RSR差异有统计学意义(χ2=75.86，P<0.001)。APC结果显示，启东市NHL 5-RSR的APC为3.40%（t=5.75，P＜0.001)，其中男性APC为4.03%（t=4.33，P＜0.001)，女性APC为7.49%（t=7.23，P＜0.001)，上升趋势均有统计学意义。年龄别5-RSR的1972-2016年长期趋势分析，35~44岁的APC为1.68%（t=2.62，P＝0.034)，45~54岁的APC为6.26%（t=4.25，P＝0.004)，55~64岁的APC为4.30%（t=5.84，P=0.001)，65~74岁的APC为5.62%（t=3.70，P=0.008)，≥75岁的APC为8.84%（t=4.68，P=0.002)，上升趋势均有统计学意义。生存率预测结果显示，至2026年NHL 5年OSR将升至39.15%，5年RSR将升至46.44%。结论:1972-2016年45年间启东市全人群NHL的生存率有了较大的提高，但仍有上升空间，应当继续重视NHL的防治研究。

Survival rate and long-term change trend of NHL in Qidong from 1972 to 2016

Objective:To analyze the survival rate of non-Hodgkin's lymphoma（NHL) in the whole population in Qidong from 1972 to 2016,and to provide a basis for prognosis evaluation and prevention.Methods:Survival outcomes of 1 990 NHL registered cases were followed up until December 31,2021.The Hakulinen method in SURV3.01 software was used to calculate the observed survival rate（OSR) and relative survival rate（RSR),and the Hakulinen's likelihood ratio test was used for statistical testing.Joinpoint regression analysis was performed with Joinpoint 4.7.0.0 software to calculate the annual percentage change（APC) of NHL survival rate,and time trend analysis was performed on the overall survival rate,gender-specific and age-specific survival rate of NHL to determine whether the long-term trend change of the rate was statistically significant.SAS9.2 software was used to predict the trend of NHL survival rate by using the ARIMA model in time series analysis.Results:From 1972 to 2016,the OSR of NHL in Qidong city in 1,5 and 10 years was 39.00%,20.39% and 15.53%.The RSR in 1,5 and 10 years was 40.18%,23.82% and 21.46%.Analysis of the survival rate in each period from 1972 to 2016,1-RSR increased from 36.66% in 1972-1976 to 55.21% in 2012-2016,and 5-RSR increased from 12.50% in 1972-1976 to 36.56% in 2012-2016,10-RSR increased from 10.92% in 1972-1976 to 22.43% in 2007-2011,the RSR rising trend in the nine periods was statistically significant（χ2=173.74,P<0.001).The 5-year RSR of males was 21.55%,and the 5-year RSR of females was 27.12%.There was no significant difference in RSR between males and females（χ2=11.54,P=0.399).The 5-year RSRs of 35~44 years old,45~54 years old,55~64 years old,65~74 years old and ≥75 years old were 23.62%,23.69%,27.87%,22.93% and 14.23%.The difference in RSR was statistically significant（χ2=75.86,P<0.001).The APC results showed that the APC of Qidong NHL 5-RSR was 3.40%（t=5.75,P＜0.001),of which the male APC was 4.03%（t=4.33,P＜0.001),and the female APC was 7.49%（t=7.23,P＜0.001),the upward trend was statistically significant.Long-term trend analysis of age-specific 5-RSR from 1972 to 2016,APC of 35~44 years old was 1.68%（t=2.62,P=0.034),and APC of 45~54 years old was 6.26%（t=4.25,P=0.004）,APC of 55~64 years old was 4.30%（t=5.84,P=0.001),APC of 65~74 years old was 5.62%（t=3.70,P=0.008),APC of ≥75 years old was 8.84%（t=4.68,P=0.002),the upward trend was statistically significant.The survival rate prediction results show that by 2026,the 5-year OSR of NHL will increase to 39.15%,and the 5-year RSR will increase to 46.44%.Conclusion:In the past 45 years(1972 to 2016),the survival rate of NHL in the whole population of Qidong city has been greatly improved,but there is still room for improvement.We should continue to pay attention to the prevention and treatment of NHL.